CMS Price Transparency Data

Culture, blood

Facility: Baylor Scott & White Medical Center Pflugerville

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $115
Cash Discount Price: $190
vs. Medicare Baseline: 11.14x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Baylor Scott & White Medical Center Pflugerville is $115. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $190. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 11.14x the Medicare baseline. Located in 2600 East Pflugerville Parkway, Pflugerville, TX.

Cash / Self-Pay

$190

Average discount available for prompt cash payment at this facility.

Insurance Median

$115

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$10.32

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $10.32 (100%)

Cash / Self-Pay: $190 (1841%)

Insurance Median: $115 (1114%)

Cash: $190 (1841% of Medicare)

Ins. Median: $115 (1114% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $10.32 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 1114% of the Medicare baseline (a markup of 1014%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Baylor Scott & White Health Plan	$10 - $136	97%
Humana	$10 - $222	97%
Superior Health Plan	$10 - $57	97%
Triwest	$10	97%
American Health Plan	$11	107%
Corvel	$11	107%
Healthspring	$11	107%
Prime Health Services	$11	107%
Procare Advantage	$11	107%
UnitedHealthcare	$11 - $12	107%
Sedgwick	$15	145%
Blue Cross Blue Shield	$50 - $61	484%
Cigna	$150 - $175	1453%
Aetna	$174	1686%
Midcoast	$174	1686%
Quiktrip	$174	1686%
University Of Mary Hardin-Baylor	$184	1783%
Independent Medical System	$190	1841%
Curative	$206	1996%
First Health	$222	2151%
Healthsmart	$222 - $237	2151%
Private Health Care System	$237	2297%
Three Rivers	$285	2762%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $190.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 87040.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Baylor Scott & White Medical Center Pflugerville is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 87040.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.